Migraine Medications (cont.)

Annette (Gbemudu) Ogbru, PharmD, MBA

Dr. Gbemudu received her B.S. in Biochemistry from Nova Southeastern University, her PharmD degree from University of Maryland, and MBA degree from University of Baltimore. She completed a one year post-doctoral fellowship with Rutgers University and Bristol Myers Squibb.

Omudhome Ogbru, PharmD

Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

For what conditions are migraine medications used?

Some of the migraine medications used to treat or prevent migraine headaches are also used for other conditions. Antidepressants, anticonvulsants, antihistamines, and narcotic pain relievers are all used in migraine therapy. There are some migraines drugs, though, that are used because they directly target the pain pathways associated with migraine headaches rather than pain pathways in general.

What are the different types of migraine medications?

Migraine medications fall into two major categories. The first contains drugs which abort or stop migraines from progressing once they begin. The earlier these drugs are used in a migraine attack, the better they work. The second category contains drugs which prevent migraines from happening.

Over-the-counter migraine medications used to address pain include analgesics, NSAIDS, and caffeine, including:

One drawback to using analgesics and NSAIDs is that taking them daily can make headaches worse due to medication overuse.

Prescription drugs used to provide relief from pain include NSAIDs and narcotics. Like over-the-counter medications, prescription drugs often come in combinations. A barbiturate called butalbital is often used in combination with acetaminophen, and caffeine with or without codeine (a narcotic). Barbiturates are a sedative and may be useful to help people sleep off the pain.

While analgesics, NSAIDs, and narcotics relieve pain, they don't address the underlying physiology -- primarily the dilation of blood vessels in the brain. Two classes of migraine drugs do: the ergotamines and the more recently available triptans.

Ergot alkaloids -- such as ergotamine tartrate (Cafergot) and dihydroergotamine mesylate (D.H.E. 45 Injection, Migranal Nasal Spray) -- are potent drugs that constrict blood vessels. Because nausea is a possible side effect of these migraine drugs, some people take ergotamines in combination with other drugs to prevent nausea.

Triptans target serotonin receptors. These drugs cause constriction of blood vessels and bring about a general interruption in the chain of chemical events that lead to a migraine. Triptans include:

While specific triptans differ in their ability to prevent a recurrence of migraine headache, they are generally equally effective in their ability to provide relief. Triptans are more migraine-specific than the earlier ergotamines.

Another migraine drug used to abort the pain of a migraine is a combination product containing the vasoconstrictor isometheptene mucate, the sedative dichloralphenazone, and the analgesic acetaminophen (Midrin). The FDA has classified isometheptene mucate as "possibly" effective for migraines, pending further review.

Antihistamines are also used to ease migraine symptoms. These drugs counteract the effect of histamine, a substance that dilates blood vessels and causes an inflammatory response in the body -- the same kinds of response seen during a migraine attack. Antihistamines are broadly grouped into sedating and non-sedating types. An example of a sedating type is diphenhydramine; an example of the non-sedating type is loratadine (Claritin).